Objectives: Post-kidney transplant proteinuria due to recurrent GN is considered to be a significant risk factor negatively affecting kidney transplant survival. In this case series we report our experience at 2 institutions with using ACTH (Adreno-corticotropic Hormone) to reduce proteinuria.

Materials and Methods: We retrospectively reviewed the available data and outcomes of the 19 transplant recipients who underwent treatment with ACTH at our institution.

Results: Mean age was 44.5+/-14.9 years (15-68); M:F 16:3; Whites: African Americans 9:8, Living Donor transplant 10/19. Indication for ACTH use was recurrent FSGS in 14, recurrent MGN in 2 and 3 others. Induction therapy : 10 Alemtuzemab: 9 Anti-thymocyte globulin. Patients were on variable immunosuppression at baseline and were adjusted or altered based on clinical status and individual provider preference. All patients were on ACE-I. 15/19 patients received steroids as part of treatment, while 9/19 patients received Plasma Exchange.

Median duration from transplant to ACTH use was 11.2 months (0-124). Median duration from diagnosis of recurrence to ACTH use was 6.9 months (0-47).

The mean starting and ending serum creatinine was 2.7+/-2.2 (1.0-10.1) and 3.6+/-2.7 mg/dL respectively, while mean Pre-ACTH and Post-ACTH or last follow up urine protein to creatinine ratio (UPC) was 6.3+/-2.9 and 4.4+/-3.8 respectively. ACTH was used at a dose of 40-80 units subcutaneously twice a week. The median treatment duration was 6.1 months (range 1.6-20.8). At end of ACTH or last follow up 8/17 (47%) of patients showed a 50% or more reduction in proteinuria from pre-ACTH levels. 7/17 (41.1%) showed less than 50% reduction, while 2/17 showed no change or worsening of proteinuria. Mean reduction was 39.8+/-52%. 4/17 cases achieved complete remission of nephrotic syndrome. Conclusions: In conclusion, we describe to date the largest series of ACTH use in the post-transplant setting. It appears that ACTH has a partial role in proteinuria response but until larger long term randomized studies are conducted, its use should still be considered with caution.

CITATION INFORMATION: Khalil A, Karabala A, Sharfuddin A, Grafals M. Treatment of Post-Transplant Nephrotic Syndrome with Adrenocorticotropic (ACTH) Gel. Am J Transplant. 2017;17 (suppl 3).

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